Just One More – Eating Disorders in the US

Thanks to all the people who answered yesterday (apparently only in their brains, not on the comment section – it’s okay you wussies, I just know you would have been wrong anyway, so there). The answer to yesterday’s question is E) Secondary Amenorrhea – cessation of a woman’s menstrual period as a result of an underlying disease or condition. The causes can range from pregnancy, breast feeding and menopause to eating disorders, Polycystic Ovarian Syndrome and hypothyroidism. Based on our patients symptoms the likely cause is Anorexia Nervosa. Why the other answers are wrong is discussed at the end of this post.

I chose this question because of an article to be published next month by the American Academy of Pediatrics discussing the rise in incidence of eating disorders among children younger than 12. You can see the PsychCentral article discussing the paper here. Did you get that? Kids younger than 12 years old….and not just girls.

The article states that eating disorders now account for up to 4% of hospitalizations for US pediatric patients. That statistic floored me and what followed in the article deserves major attention by doctors and students of medicine, as well as the national media.

Pediatricians and Family Practice doctors need to be more informed about these diseases. They need to be aware that eating disorders aren’t just affecting females. And that being a normal (or even higher than normal) weight absolutely does not rule out the possibility of a patient having an eating disorder. These doctors need to learn to screen for these diseases. They need to understand that males now comprise almost 10% of all eating disorder diagnoses. So, why don’t they know these things?

We have literally barely touched on eating disorders in my 1.5 years of medical school. I don’t even know if most of my classmates could tell you the difference between Anorexia Nervosa and Bulimia. I’m pretty sure most of them wouldn’t be able to tell you there are other types of eating disorders, like EDNOS (Eating Disorder Not Otherwise Specified) and Binge Eating Disorder and Pervasive Refusal Syndrome (similar to Anorexia, but occurring before puberty) and Night Eating Syndrome – all real eating disorders as defined by the DSM-IV (a Psychiatrist’s Bible) or it’s appendix. This doesn’t even touch on things like Pica (cravings for non-food items like chalk, coffee ground or ashes) and rumination which are currently defined as “feeding disorders,” generally of infancy and childhood, but definitely not exclusive to such a time period.

Why does it matter if they know that since they aren’t going into Psychiatry?

Well, frankly, because Psychiatrists are rarely the people who are having to screen for these disorders – they are the ones who treat them. Eating Disorders need to be caught at yearly physical exams or sick exams to prevent them from getting to a deadly stage. If doctors were supplied with a more appropriate skill set to identify possible cases of these disorders, there would be a much higher potential for these patients to be referred for counseling before their disease got even worse. If doctors were screening for Eating Disorders like they screen for – oh I don’t know – Scoliosis, how many lives could be saved? I’m not just talking decreasing the lethality of these disorders, I’m talking about changing lives. Preventing downward spirals. Ending bad habits before they become worse. Allowing a child who doesn’t know how to ask for help the opportunity to access it before they are so sick a bystander can tell they have an eating disorder.

There are often many, many more aspects to an Eating Disorder than weight alone. Almost invariably the patient is suffering from low self-esteem along with some kind of control issues. Physical, verbal or emotional abuse is a common co-morbidity, whether it be from a sibling, parent, classmate or significant other. The physical manifestations of a long-term struggle with these diseases can be debilitating and even deadly. In 1995 a study indicated that, for females age fifteen to twenty-four years old suffering from Anorexia Nervosa, the mortality rate associated with the illness was twelve times higher than the death rate of ALL other causes of death. I realize this is an outdated study, but with the incidence of eating disorders on the rise I can only infer that the mortality rate from these diseases is still very high.

If an adolescent suffers from a long-term eating disorder yet escapes lethality as a consequence, the aftermath can still be extremely caustic. From brain atrophy, scurvy and tooth decay to osteoporosis and extreme loss of bone density before age 30, not to mention the social and occupational effects that are so common. If we caught these things earlier, we could change some of these outcomes.

So, what do you think, friends inside the internet? Would you like to see more screening for Eating Disorders by Pediatricians and Family Practice doctors who are seeing children? Do these doctors owe it to their patients to be more educated about this? Should it be a required screening program?

How can we help keep these kids from being Just One More?

Incorrect Answers:A) Calluses on hand/fingers (Also known as Russel’s Sign – an indicator of induced vomiting) and B) Dental Erosions could both be symptoms of Bulimia or other eating disorders, even Anorexia, but these answers are not “as good” as Secondary Amenorrhea. Although someone with Bulimia might also experience secondary amenorrhea, it is much more common in those who have Anorexia, since bulimics are more often of normal (or higher) weight. Unfortunately, this makes Bulimia a very difficult disorder for physicians to detect and it is most often discovered by a family member or house mate.

C) Hirsutism is a condition of excessive hairiness. It has many causes, but eating disorders are not one of them. Lanugo, a fine hair that grows on fetuses, can also present on those who are malnourished due to Eating Disorders or other causes, but it does not fall into the category of hirsutism.

D) Primary Amenorrhea is absence of menarche by the age of 16. Our patient does not have this.

I remember when I did gymnastics it seemed more and more gyms were constantly weighing gymnasts and coaches would make comments about us being too "chubby" and needing to use our time to run instead of eat. And none of my teammates were anywhere near being overweight! I guess my point is that the pressure to be thin is coming from so many angles at such an earlier age that it's incredibly important for doctors and parents to become educated and possibly able to screen as you said. Sorry for rambling as always!

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I’m an Ob/Gyn resident (that means I went to medical school to become a doctor) and now I'm working like a crazy person to learn my trade before I'm on my own in the wild. Once upon a time I birthed a couple of babies of my own, they're friggin' adorable twin toddlers now. My life story through November 2010 can be viewed here. The events in the many years following can be summed up as wedding bells, books, exams, babies, and doctoring. I only started this blog in hopes of landing a role in a Lifetime movie so I could quit medicine and move to Hollywood, so if you wouldn't take medical advice from Angelina Jolie, you shouldn't take it from me. I may not even be a real person. In fact, I'm probably a spambot. Or possibly a 15 yo boy blogging from a dingy basement. If you're really interested you can read more about me here. If you have any questions or want to guest post contact me.